Physicians Practice - June 2008 - (Page 54) ASK THE EXPERTS ried to the practice management system. For example, IDX (now GE Centricity) has a very strong solution that indexes the EOB directly to the charge transaction on the patient’s financial record. It may also be helpful if they are applying the ERA (electronic remittance advice) as they will have detail (including dates) that will help drive to the desired info. Bottom line: try to work with the provider of your practice management system. cost projections over the first year. It would be less risky to grow organically. Consider the reimbursement scenarios for your employed physicians. Pediatrics is high-volume, as you know. Flat salaries don’t encourage productivity. Consider recruitment scenarios for employed physicians. A good, experienced doc with a following is unlikely to join as an employee. She’ll want a piece of the pie and longer-term security. She’d certainly not want to report to a manager. It may be OK report. Can I bill it as a consult even though the patient is established? What if the patient was sent by the same referring doc but for an entirely different medical problem? Pediatrics is high-volume, as you know. Flat salaries don’t encourage productivity. MOTIVATE A Yes, you can code a consult for an established patient, regardless of the condition. For example, primary-care physicians can code for preoperative consults requested by surgeons even for patients they see all the time for related issues. I think your bigger issue is whether this is indeed a referral or a consult. If the ophthalmologist specifically seeks your opinion, it’s a consult. If she is asking you to solve this problem for the patient to take over care — then it’s a referral and should be billed as an established visit. Search “consult” at www.PhysiciansPractice.com for some articles on this distinction. PAIN PUMP CODING Q Is there a procedure code for placement of a pain pump after 15830 and 49587? STARTING A NEW PRACTICE Q I am an employed pediatrician considering going into equal partnership with the administrator of another practice. Our goal would be to develop offices in several locations, employing others to staff them. What is wrong with this picture? What should I be aware of? What precautions should I take? A Here are a couple of things that come to mind: What are the state laws concerning how your practice can be organized? Is it an LLC? You may not be allowed to form a professional corporation with a manager as a partner and there may be negative tax consequences. Just look into how you’ll form. Carefully work through what happens if you or the administrator leave or are asked to leave. Why multiple locations to start? You'll have extremely high overhead and low revenue in the beginning. You'll want a robust business plan with detailed expected revenue and 54 | PHYSICIANS PRACTICE | JUNE 2008 to have mostly young physicians who rotate out as they get older, but keep in mind the impact on patient loyalty and revenue (slower physicians, high recruitment costs). What distinguishes these practices from all the others in your area? What is your brand? What would make a mom switch practices to you? Or would you target newcomers? If so, would you do hospital rounds to infants? How does that impact the staffing and reimbursements model? None of these issues are insurmountable. You'll just want to make sure you have it covered. CONSULTS ON ESTABLISHED PATIENTS A You'll need to check with your carriers. However, most do not reimburse separately for insertion of pain pumps, considering it part of the surgical package; this is Medicare's stance. According to the Medicare Carriers Manual section 4820-4830 or 100-04 Claims Processing Section 30, postop pain management is included in surgical procedures. There are no CPT or HCPCS codes that describe placement of a pain pump catheter. For example, code 37202 is a cardiac procedure, not a pain pump insertion into a muscle or site. • Q I’m an ENT. Last week, I saw a patient previously referred to me by an internist. The patient’s last visit was 13 months ago for otalgia. He is now referred to me by an ophthalmologist for an entirely unrelated medical problem (obstructed lacrimal duct). The ophthalmologist obviously wants a consult-like Pamela L. Moore, PhD, CPC, senior editor of practice management for Physicians Practice, is this month’s expert. Moore has been writing for physicians on practice management issues for 10 years, and she is a recognized speaker and commentator on healthcare management. She can be reached at pmoore@physicianspractice.com. WWW.PHYSICIANSPRACTICE.COM http://WWW.PHYSICIANSPRACTICE.COM http://WWW.PHYSICIANSPRACTICE.COM http://WWW.PHYSICIANSPRACTICE.COM
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